家庭病房晚期癌患者皮下与硬膜外自控镇痛的效果比较

A Comparative study of patient-controlled epidural analgesia and subcutaneous analgesia for advanced cancer patients in familial-ward

目的比较患者皮下自控镇痛(PCSA)与硬膜外自控镇痛(PCEA)在家庭病房晚期癌痛治疗中的疗效及安全性。方法32例患者随机分为二组,每组各16例。PCSA组:为100ml液体中含芬太尼30μg、氟哌啶5mg、玻璃酸酶500U,PCSA泵注前先经肌肉注射芬太尼1μg/kg、氟哌利多0.05mg/kg、PCA每次0.5ml,背景输注量2ml/h,锁定时间15min。PCEA组:为100ml液体中含0.75%布比卡因25ml、芬太尼500μg、氟哌利多5mg,置管后注入负荷剂量5ml,PCA每次0.5ml,PCEA2ml/h,锁定时间15min。观察患者第1、3、7天的心率、血压、呼吸频率、VAS、镇静评分及镇痛期间的其它不良反应。结果首日PCEA镇痛效果优于PCSA,其它时间段两种镇痛方法的总体满意度无明显差异。腹胀、尿潴留及穿刺部位炎症不良反应发生率PCEA组明显高于PCSA组(P<0.05),头晕、嗜睡则以PCSA为著。结论PCEA组患者镇痛效果确切,PCSA不良反应少,安全、经济、管理方便。

Objective To compare the efficacy and safety of patient-controlled analgesia by either subcutaneous or epidural for advanced cancer patients in familiai-ward.Methods Thirty-two patients were randomly allocated to patient-controlled epidural （PCEA） group or patient-controlled subcutaneous （PCSA）group （16 in each group）.Group PGEA was given loading dose of 5ml,PCA bolus 0.5ml,background 2ml/h,lockout time 15min.In Group PCSA, patients received lμg/kg of fentanyl and 0.05mg/kg dropefidol by intramuscular injection before using a patient-controlled analgesic （PCA）delivery system. loading dose of 5ml,PCA bolus 0.5ml,background 2kl/h,lockout time 15min.Heart rate,blood pressure, respi-ratory rate,pulse,VAS,sedation score （ss） of the patients as well as adverse reactions were observed. Results Group PCEA was superior to Group PCSA in the analgesia profile in the first 24h;in the other 6 time, there were no distinct differences between the two groups.In the incidence of nausea, flatus passage, urinary retention and part of puncture inflammation, group PCEA was higher than group PCSA. Conclusion There is higher analgesic efficacy in the group PCEA.The group PCSA could be managed with convenience, safety , economy and fewer adverse reactions.